Heart attack risk with NSAIDS

2nd June 2006

A study in this week's BMJ finds that high doses of some traditional non-steroidal anti-inflammatory drugs (NSAIDS) are associated with similar cardiovascular risks as the new generation of anti-inflammatory drugs known as COX 2 inhibitors like Vioxx ® - which was taken off the market after concerns about the risk of heart attack.

By including data from 138 trials among 140,000 patients, this meta-analysis provides a much more reliable estimate of the cardiovascular risks of these drugs, since individual trials were too small to study this question.

The study, by researchers from the UK and Italy, showed as expected that COX 2 inhibitors were associated with an increased risk of vascular events, mainly heart attack. Unfortunately, there were insufficient data to reliably assess whether these risks were dose dependent, or whether the risks might differ among aspirin and non-aspirin users.

The study also showed that high doses of two of the NSAIDs studied, ibuprofen and diclofenac, were associated with a similar increase in the risk of vascular events to COX 2 inhibitors, although the risks of high doses of naproxen, another NSAID, were smaller.

The average increased risk of vascular events was modest among the people studied in the trials; for every 1,000 people taking an NSAID or COX 2 inhibitor, around three extra people per year would have a vascular event, most likely a heart attack, said the BMJ.

The authors conclude that very large randomised trials are needed to identify which anti-inflammatory drug regimens minimise serious gastrointestinal and cardiovascular problems. Doctors should work with their patients to choose the best solutions for them, and discuss other options for treating chronic pain suggests an accompanying editorial in the BMJ.

The lead researcher of the study, Dr Colin Baigent, said that the important point to remember is that for most people who don't have a history of heart attack or stroke the risk is very small. He added that it is for patients to discuss with their doctors whether this risk is acceptable for them as the drugs are very important in helping people to control their pain.

Medical Director of the British Heart Foundation, Professor Peter Weissberg, said there was mounting evidence that taking high doses of NSAIDs increases the chances of heart attack. However he stressed that the increased risk is small and many patients with chronic debilitating pain may well feel that this small risk is worth taking to relieve their symptoms.